The Practice is ACCEPTING NEW PATIENTS for office, video/chat/online, and onsite services in both the District of Columbia and Florida. And the practice bills out of network health insurance in one of two ways: 1) using real time electronic billing to your carrier or 2) generating the needed record for clients to submit.
How do I know if my carrier re-imburses for out of network mental health?
In network and out of network coverage varies by carrier. If you’re dependent on health insurance (meaning this is the primary decision guiding which provider you see) you’ll want to contact your carrier (here is a full list of carriers in the US and contact information). You can also call the phone number on the back of your health insurance card or log in to your insurance carriers website to see what is and is not covered. If a provider is in network or out of network (and who pays for what and when) is really determined by your policy – not your provider. Beginning with the carrier is a good bet, instead of contacting providers first. Providers, even those who are in network, really do not know what the insurance will and will not do as there are so many random changes and variables that are constant in the third party payor system. Being dependent on coverage as the guide for your care and/or electing who you want to see based on your preferences and ability to afford the care are parts of deciding who to see.
Instant electronic filing or paper filing of claims explained.
Because the practice uses advanced private practice digital technology, we are able to electronically bill your insurance company at the time of your session! Unlike other billers, using either paper forms or billing agents, this practice utilizes “point of session insurance claims billing.” This means re-imbursements to clients come much faster and there is a digital footprint of the claim submission and its acceptance by the carrier meeting their claims processing requirements. And for those clients who wish to submit their own claims, the required document is printed at the time of the session, ready for clients to submit. In either regard, billing insurance is now faster than ever, with real time “point of session” electronic billing or point of session document generation for clients to bill. *
Insurance acceptance and billing is not the same thing as whether or not your carrier covers you.
Insurance is accepted as an out of network provider where services are arranged between you and the practice and your carrier is billed to re-imburse you in accordance with you and their contract terms. After years of accepting in network insurance with as many as 18 to 20 different payors (both public and private) where payment delays and random “glitches” related to insurance “delay of payment” or “continuous modification requests to claims” the practice moved to accepting out of network benefits effective in February 2018.
Clients have to navigate premiums, deductibles, co-insurance, co-pays and “allowables” for policies that are as varied as the carriers. While many legal structures are in place for more standardized health insurance policies – loopholes and annual updates make policy shifts between hundreds and hundreds of carriers and thousands and thousands of policies a bit of quagmire. Buyer beware is a good way to proceed.
Out of network coverage allows users to take advantage of services in the office and online including 24/7 connect now options as well as video, chat, journal and file sharing based therapies (including those now available by smart phone and tablet in the encrypted secure client area); much of these types of online therapy options, those that support and occur in between face to face sessions or instead of face to face sessions, are not covered by in or out of network policies.
When you schedule your first appointment you will be able to review and elect what billing options you prefer related to out of network coverage factors. For out of network billing, payment for services is arranged between you and the practice first and then re-imbursement occurs between you and your carrier afterwards. Real time point of session electronic billing can speed up your re-imbursement time (and there are costs incurred for electronic real time billing) however clients are asked to be patient in the first month or so of billing as nearly 100% of payers have some form of delay that can be predicted with initial (and sometimes subsequent) claims. You may need to call your carrier if they accept claims but adjudicate non-covered where you think your policy (or you’ve been told that) covers out of network sessions.
Clients have been getting better here since 2005 with shorter service times and improved outcomes because of self scheduling (even before the digital server technology) and because the treatment planning documents are built with the client goals in mind! With Healthgrades reviews being some of the highest in the US I’m proud to see people get better and then move on to tell others about their time here.”
—- Kurt LaRose
Using a Health Savings Account Credit Card?
Because the practice is registered as a mental health services company with merchant services for credit cards, the practice does accept and bill HSA cards at the time of the session! This is an added service to help clients better manage healthcare costs and benefits.
*Note: You will enter your health insurance and HSA card information when scheduling your first appointment using our online secure server (accessible 24 hours a day). Electronic filing set up time may be required at or during the first session, such that your first claim may not be submitted real time; subsequent claims are real time. The practice assesses an electronic claims processing and handling fee per month for out of network insurance billing services. This fee is discussed in the initial consultation. Clients who utilize insurance should consult their carrier and policies for services that are covered in the office, online and/or onsite prior to being seen!
Insurance billing, diagnosis with pros and cons …
Not everyone cares about what information is shared with their insurance company, even as all providers who bill insurance share the same basic information. The same basic information? Yes, since it is required by insurance carrier in order to bill them and to justify medically necessary payments. There are certain laws that come into play with insurance billing and general privacy rules particularly for digital services, and even social media policies (see Practice Privacy Statement, Social Media Policy Statement, Patient Bill of Rights ). If you’re interested in learning more about what health information is shared with your carrier you learn some of the basics (along with the pros and cons of diagnosis) click here or read on a bit more. During the initial consultation all your questions and concerns can be discussed as you proceed; the more you ask the better!
In my recent RadioPublic Podcast I discussed the impact of healthcare and health insurance on providers and patients in the US. This side of the story is not addressed in the current debates and trends in a decades and decades old problem. At least, this is my voice ….
What exactly is shared when I use my insurance, my credit cards and are there other entities who get information that I normally would not be aware of?
When you set up your digital entry to the private practice (online 24 hours a day) and schedule your first session you will be required to read and agree to a wealth of information regarding how your medical information is used with insurance. Too you will agree in how information is used with credit card processors, billing agents, collections if that ever becomes necessary, as well as data sharing between secure servers of various electronic gateways, file transfers and other parties under certain other circumstances. Too, there is specific added information that many clients are not aware that insurance companies pass along and have done so for many years to a healthcare data bank conglomerate outside of engaging with the mental healthcare provider.
The shared and non-shared information is summarized in detail when you register in the client portal. In your portal to the practice client data is not shared outside of the practice without consent and unless third party billing is elected. Only payment data (between you, your bank and the practice for fees) is reported outside of the server otherwise.
A provider who bills insurance will use various diagnosis codes in billing the insurance company; in certain scenarios health information that is sent to your insurance company as a matter of billing, could be forwarded by that company to the MIB (see below) without your specifically expressed permission. Most insurance companies participate in what was once called the Medical Information Bureau, still operating as MIB. More information can be found here: https://en.wikipedia.org/wiki/MIB_Group. In self pay scenarios, since the insurance company is not billed with a diagnosis code, the sharing of such information, if it were reported, is not occurring.
What’s cool in the use of the encrypted server at TalkifUwant is that even the administration of the server do not have access to your information due to encryption!
Is all of this necessary?
The answer here would depend on your perspective about data sharing and just how private you would like your health information to be and as mentioned earlier if you are dependent on insurance to access care. Either way, knowing how your information is used is key to you being informed and being comfortable, as well as knowing what you have right to protect and keep private too. And yes, your agreement is needed as a number of legal actions are affected by your consent and/or your refusal to allow such data sharing.
When you enter a mental health practitioners office you are accessing healthcare. It is at that engaging moment a whole series of laws, rules and regulations kick in. The same is true when you use a credit card frankly. If you were to enter the ER you would be greeted at some point with a stack of papers or a digital screen to sign so that billing matters (and data sharing disclosures) are obtained. Healthcare includes mental health. That is true in a big hospital and in a solo private practice!
Know your healthcare rights – and you have many, as published here on the TalkifUwant website. Know your privacy rights and records access (and even records correction rights) as well. And in the advent of modern day mental health, where face to face and online services are now a contemporary reality, there are even ethics, rules and codes covering social media engagement! This is all about you! And you have allot of power in what can (and cannot) be done with and about your healthcare.
STILL HAVE QUESTIONS?
Text if you have a general question about billing, insurance or scheduling—anytime. Please do not text mental health information as texting is not yet recognized as a secure and confidential platform for sharing and discussing mental health information. General questions may be texted to: 850-545-2886.
- | Social Media Policy Statement
- | Practice Privacy Statement
- | Insurance Disclosures
- | Encrypted Mental Healthcare
- | Online Therapy Implications
- | TalkfUwant Articles and Website Overview